No abstract

Solid-organ transplant recipients who are receiving immunosuppressive therapy are at increased risk of acquiring opportunistic infections, particularly fungal infections. We present the cases of five liver transplant recipients who developed primary cutaneous opportunistic fungal infections that remained localized to the skin. These cases are compared with 27 previously reported cases of primary cutaneous fungal infections. In these previously reported cases, administration of systemic antifungal medications, including amphotericin B, ketoconazole, griseofulvin, and miconazole, resulted in a 71% survival rate. Medical and surgical therapy together resulted in an 86% survival rate, and surgical excision resulted in a 100% survival rate. Thus, regardless of the age of the patient, type of immunosuppressive therapy, clinical presentation, or organisms involved, surgical excision yielded the highest cure rate. When possible, surgical excision should be performed on solid-organ transplant recipients who acquire opportunistic fungal infections.

Perioral dark brown macules quickly identify patients with Peutz-Jeghers syndrome. These lentigines may be cosmetically disfiguring. We report a successful outcome in the treatment of these lentigines with the carbon dioxide laser.

Objective. Evidence suggests that patients with in vivo speckled antinuclear antibody (ANA) patterns have high titers of circulating ANA, specifically anti-U1 RNP antibody. A small percentage of patients with high titers of anti-U1 RNP antibody have anti-nuclear matrix antibodies, and some also demonstrate in vivo ANA. This study was designed to screen for the presence of antinuclear matrix antibodies in patients with in vivo ANA.Methods. Anti-nuclear matrix antibodies were detected by indirect immunofluorescence on HCIextracted HEp-2 cell substrate, by enzyme-linked immunosorbent assay, and by immunoblot analysis.Results. All 10 patients with in vivo ANA were found to have anti-nuclear matrix antibody demonstrated using HC1-extracted HEp-2 cell substrate, and all exhibited antibody activity to a 36-kd protein from nuclear matrix antigen.Conclusion. These results suggest that antinuclear matrix antibodies are a major factor in the development of in vivo ANA.

Glomus tumors may occur as solitary lesions, or rarely as multiple glomus tumors (MGT). Internal organ involvement in patients with MGT has been reported, but is rare. Magnetic resonance imaging (MRI) has been reported to be useful in evaluating patients with blue rubber bleb nevus syndrome for nongastrointestinal internal organ involvement. Three patients with MGT were evaluated by MRI for both cutaneous and internal involvement. MRI, which is useful in evaluating other vascular lesions, is not useful in the evaluation of patients with multiple glomus tumors. With these results, patients with MGT can be spared the expense of MRI procedure.